Provider Demographics
NPI:1144705948
Name:PAVON, LORELY CLARA (APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:LORELY
Middle Name:CLARA
Last Name:PAVON
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13435 SW 67TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2353
Mailing Address - Country:US
Mailing Address - Phone:786-972-0617
Mailing Address - Fax:
Practice Address - Street 1:1475 NW 12TH AVE STE 1175D
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1002
Practice Address - Country:US
Practice Address - Phone:305-243-9053
Practice Address - Fax:305-243-1432
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9272363363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily